Impaired fibrinolysis in severe Covid-19 infection is detectable in early stages of the disease

BACKGROUND

A significant degree of mortality and morbidity in Covid-19 is due to thromboembolic disease. Coagulopathy has been well described in critically unwell patients on ICU. There is less clear evidence regarding these changes at the time of presentation to the Emergency Department and the progression of disease over time.

OBJECTIVE

We sought to investigate whether coagulation markers can predict severity and how they change over the disease course.

METHODS

Patients presenting to a single University Teaching Hospital were recruited and followed up if PCR was positive. Alongside routine blood testing, Rotational Thromboelastometry (ROTEM) was performed. Outcome data was recorded for all patients, and ROTEM values were compared across outcome groups.

RESULTS

Extem and Intem Maximum Lysis were significantly reduced in those who died or required an ICU admission, indicating a reduced ability to break down clot mass in the most critically unwell patients.

CONCLUSION

Comparisons between groups demonstrated that one distinguishing feature between those who require ICU admission or die of Covid-19 compared with those who survive a hospital stay to discharge was the extent to which fibrinolysis could occur. Mortality and morbidity in Covid-19 infection appears in part driven by an inability to break down clot mass.

Lipogenesis mediated by OGR1 regulates metabolic adaptation to acid stress in cancer cells via autophagy

Malignant tumors exhibit altered metabolism resulting in a highly acidic extracellular microenvironment. Here, we show that cytoplasmic lipid droplet (LD) accumulation, indicative of a lipogenic phenotype, is a cellular adaption to extracellular acidity. LD marker PLIN2 is strongly associated with poor overall survival in breast cancer patients. Acid-induced LD accumulation is triggered by activation of the acid-sensing G-protein-coupled receptor (GPCR) OGR1, which is expressed highly in breast tumors. OGR1 depletion inhibits acid-induced lipid accumulation, while activation by a synthetic agonist triggers LD formation. Inhibition of OGR1 downstream signaling abrogates the lipogenic phenotype, which can be rescued with OGR1 ectopic expression. OGR1-depleted cells show growth inhibition under acidic growth conditions in vitro and tumor formation in vivo. Isotope tracing shows that the source of lipid precursors is primarily autophagy-derived ketogenic amino acids. OGR1-depleted cells are defective in endoplasmic reticulum stress response and autophagy and hence fail to accumulate LDs affecting survival under acidic stress.

Dual Singlet Excited-State Quenching Mechanisms in an Artificial Caroteno-Phthalocyanine Light Harvesting Antenna

Under excess illumination, photosystem II of plants dissipates excess energy through the quenching of chlorophyll fluorescence in the light harvesting antenna. Various models involving chlorophyll quenching by carotenoids have been proposed, including (i) direct energy transfer from chlorophyll to the low-lying optically forbidden carotenoid S₁ state, (ii) formation of a collective quenched chlorophyll–carotenoid S₁ excitonic state, (iii) chlorophyll–carotenoid charge separation and recombination, and (iv) chlorophyll–chlorophyll charge separation and recombination. In previous work, the first three processes were mimicked in model systems: in a Zn-phthalocyanine–carotenoid dyad with an amide linker, direct energy transfer was observed by femtosecond transient absorption spectroscopy, whereas in a Zn-phthalocyanine–carotenoid dyad with an amine linker excitonic quenching was demonstrated. Here, we present a transient absorption spectroscopic study on a Zn-phthalocyanine–carotenoid dyad with a phenylene linker. We observe that two quenching phases of the phthalocyanine excited state exist at 77 and 213 ps in addition to an unquenched phase at 2.7 ns. Within our instrument response of ∼100 fs, carotenoid S₁ features rise which point at an excitonic quenching mechanism. Strikingly, we observe an additional rise of carotenoid S₁ features at 3.6 ps, which shows that a direct energy transfer mechanism in an inverted kinetics regime is also in effect. We assign the 77 ps decay component to excitonic quenching and the 3.6 ps/213 ps rise and decay components to direct energy transfer. Our results indicate that dual quenching mechanisms may be active in the same molecular system, in addition to an unquenched fraction. Computational chemistry results indicate the presence of multiple conformers where one of the dihedral angles of the phenylene linker assumes distinct values. We propose that the parallel quenching pathways and the unquenched fraction result from such conformational subpopulations. Our results suggest that it is possible to switch between different regimes of quenching and nonquenching through a conformational change on the same molecule, offering insights into potential mechanisms used in biological photosynthesis to adapt to light intensity changes on fast time scales.

Practice patterns of pediatric total body irradiation techniques: A Children's Oncology Group survey

PURPOSE

The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among xxx member institutions.

METHODS AND MATERIALS

Between Nov 2019 and Feb 2020 a questionnaire, containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 xxx institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 xxx member radiation oncologists at the same institutions.

RESULTS

Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions responded (69% response rate). The AP/PA technique was the most common (49 institutions - 56%); 44 institutions (50%) used the lateral technique and 14 institutions (16%) used volumetric modulated arc therapy (VMAT)/Tomotherapy. Mid-plane dose rates of 6-15 cGy/min were most commonly used. The most common specification for lung dose was the mid lung dose for both AP/PA (71%) and lateral (63%) techniques. All physician responders agreed with the need to refine current TBI techniques and 79% supported the investigation of new TBI techniques to further lower the lung dose.

CONCLUSION

There is no consistency in the practice patterns, methods for dose measurement and reporting of TBI doses among xxx institutions. The lack of a standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The xxx radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all xxx centers.

CD40 agonist-induced IL-12p40 potentiates hepatotoxicity

Background

CD40 is a compelling target for cancer immunotherapy, however, attempts to successfully target this pathway have consistently been hampered by dose-limiting toxicity issues in the clinic that prevents the administration of efficacious doses.

Methods

Here, using cytokine and cytokine receptor depletion strategies in conjunction with a potent CD40 agonist, we investigated mechanisms underlying the two primary sources of CD40 agonist-associated toxicity, hepatotoxicity and cytokine release syndrome (CRS).

Results

We demonstrate that CD40 agonist -induced hepatotoxicity and CRS are mechanistically independent. Historical data have supported a role for interleukin-6 (IL-6) in CRS-associated wasting, however, our findings instead show that an inflammatory cytokine network involving TNF, IL-12p40, and IFNγ underlie this process. Deficiency of TNF or IFNγ did not influence CD40-induced hepatitis however loss of IL-12p40 significantly decreased circulating concentrations of liver enzymes and reduced the frequency of activated CD14⁺MHCII⁺ myeloid cells in the liver, indicating a role for IL-12p40 in liver pathology.

Conclusions

As clinical research programs aim to circumnavigate toxicity concerns while maintaining antitumor efficacy it will be essential to understand which features of CD40 biology mediate antitumor function to develop both safe and efficacious agonists.

Abstract 2960: A novel mouse model of pancreatic cancer reveals new insights into cell cycle deregulation

Overcoming checkpoints to cell cycle control is the basis for tumorigenesis and malignant growth. Therefore, models that recapitulate clinically relevant cell cycle deregulation enhance our understanding of defined tumors subsets. Specifically, pancreatic ductal adenocarcinomas (PDAs) frequently delete the 9p21 locus which contains the cyclin dependent kinase (CDK) inhibitors CDKN2A (p16, p14) and CDKN2B (p15), as well as methylthioadenosine phosphorylase (MTAP), a metabolic gene required for methionine salvage from methylthioadenosine. No model currently exists that accurately represents loss of the entire locus in a relevant disease context. Moreover, the contribution of MTAP to tumor progression remains largely unknown. Therefore, we have developed a novel genetically engineered mouse model (GEMM) of PDA which combines loss of the orthologous murine 9p21 region (4qC4) with activated KRAS [Pdx-Cre; LSL-KrasG12D; 9p21L/L (K9C)], which results in rapid adenocarcinoma formation and subsequent mortality in mice homozygous for 9p21 deletion. Single-cell RNA sequencing revealed a remarkable level of inter- and intra-tumoral heterogeneity, including a significant immune and stromal component that contribute to tumor growth and progression. Additionally, K9C derived cell lines are responsive to Pfizer's first-in class CDK2/4/6 selective inhibitor while displaying de novo resistance to CDK4/6 inhibitor Palbociclib. Allograft and single-cell RNA sequencing experiments corroborated these findings and implicate Myc in contributing to CDK2/4/6i sensitivity. Furthermore, phenotypic-based screens revealed synthetic-lethal hits with 9p21 loss, indicating ample opportunities for combination strategies in this select patient population. Thus, we show that the K9C model recapitulates salient aspects of PDA and is amenable to novel therapeutic intervention strategies that may aid in improving the outcomes of patients with this precise genetic background.

*All procedures performed on animals were in accordance with regulations and established guidelines and were reviewed and approved by an Institutional Animal Care and use committee

Citation Format: Christina Adams, Lynn Wang, Tim S. Wang, Nichol Miller, Elizabeth McMillan, Monica Ramstetter, John Chionis, Koleen Eisele, Jonathan Almaden, Timothy Affolter, Smitha Pillai, Todd VanArsdale, Chris Dillon, Stephen G. Dann. A novel mouse model of pancreatic cancer reveals new insights into cell cycle deregulation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2960.

P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

Introduction

Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients.

Methods

A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review.

Results

Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%).

Discussion

Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

The treatment effect of rivaroxaban on clot characteristics in patients who present acutely with first time deep vein thrombosis

BACKGROUND

The acute vascular disease deep vein thrombosis (DVT) requires oral anticoagulants to prevent progression. Monitoring therapeutic efficacy of direct oral anticoagulants (DOAC), including rivaroxaban, is problematic as no reliable test is available. Advances in rheometry have led to the development of a functional coagulation biomarker using Gel Point (GP) analysis which assesses clot structure formation. The biomarker measures incipient clot formation time (TGP) and quantifies fibrin clot structure in terms of fractal dimension (df).

OBJECTIVE

This study aimed to investigate clot structure formation in first time DVT and the effect of rivaroxaban treatment.

METHODS

This prospective observational cohort study measured the GP and standard laboratory markers at three sample points: pre-treatment and at 20 and 60 days following 15 mg BD and 20 mg OD rivaroxaban respectively.

RESULTS

Forty DVT patients (mean age 64 years [SD±14.8]; 23 males, 17 female) were recruited. The results show that DVT vs non-DVT patients did not have a significantly different GP profile (df: 1.72±0.06 vs 1.70±0.06 and TGP: 267±68 sec vs 262±73 sec) with both within the defined healthy index. In addition, rivaroxaban therapy increased TGP to 392 s (±135 s) after 20 days, and subsequently increased to 395 s (±194 s) at 60 days but did not significantly increase df (from 1.69±0.05 to 1.71±0.06).

CONCLUSIONS

The results indicate in this cohort of DVT patients there was no underlying hypercoagulable effect as determined by gel point analysis. Furthermore, the anticoagulant effect of rivaroxaban prolonged clotting, suggesting a protective effect against clot formation, without significantly reducing clot microstructural properties.

Hand tendon injuries

This article provides a comprehensive overview of hand tendon injuries. It has been tailored towards healthcare professionals who will be the first to assess these injuries and instigate appropriate management. It discusses the essential hand anatomy to be aware of, how to assess tendon injuries, their initial management and also the definitive surgical interventions used, if required. Rehabilitation techniques are also discussed, as this is also key to good functional outcomes. Missed injuries, or delay in their diagnosis and referral to specialist hand surgeons, can cause a large amount of morbidity for patients and therefore it is important that they are picked up in a timely manner.

Hand infections

The hand is an extremely versatile organ adapted for fine tasks with various clinicoanatomical compartments. This article reviews the types of common hand infections that present to the emergency department and/or hand surgeon, with relevant investigations and strategies for diagnosis and treatment, with the emphasis on distinguishing between superficial and more serious infections.

OP0228 EFFICACY AND SAFETY OF IXEKIZUMAB VERSUS ADALIMUMAB (SPIRIT-H2H) WITH AND WITHOUT CONCOMITANT CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARD) IN BIOLOGIC DMARD-NAÏVE PATIENTS WITH PSORIATIC ARTHRITIS: 52-WEEK RESULTS

Background:

Ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting IL-17A, was superior to adalimumab (ADA) at Week (Wk) 24 for simultaneous achievement of ACR50 and 100% improvement from baseline in the Psoriasis Area and Severity Index (PASI 100) (primary endpoint) in patients (pts) with active PsA from SPIRIT-H2H1. SPIRIT-H2H had two major secondary endpoints and achieved both: noninferiority of IXE to ADA for ACR50 at Wk 24, and superiority of IXE to ADA for PASI 100 at Wk 24.

Objectives:

To determine how concomitant conventional synthetic DMARD (csDMARD) use affects safety and efficacy of IXE and ADA in prespecified subgroups defined by biologic monotherapy, concomitant MTX use, and concomitant csDMARD use through Wk 52 in SPIRIT-H2H.

Methods:

SPIRIT-H2H (NCT03151551) was a 52-week, multicentre, randomised, open-label, assessor-blinded, parallel-group study evaluating the efficacy and safety of IXE versus ADA in adults with PsA and naïve to biologic DMARDs. Patients were required to have active PsA fulfilling Classification for Psoriatic Arthritis (CASPAR) criteria and ≥3/68 tender and ≥3/66 swollen joints, ≥3% plaque psoriasis BSA involvement, no prior treatment with bDMARDs, and with prior inadequate response to ≥1 csDMARD (but not necessarily current treatment with csDMARDs). Randomization (1:1) was stratified by concomitant use of csDMARD and the presence/absence of moderate to severe PsO (baseline: BSA≥10% + PASI≥12, + static Physician’s Global Assessment≥3). Patients (N=566) received IXE/ADA through 52 wks according to the labelled dose dependent on presence/absence of moderate-to-severe PsO. In this prespecified subgroup analysis by presence or absence of csDMARDs, efficacy outcomes through wk 52 were compared between IXE and ADA using logistic regression models and Fisher’s exact tests. Missing data were imputed using non-responder imputation.

Results:

At baseline, 167 of 283 IXE-treated patients and 169 of 283 ADA-treated patients had concomitant MTX use. Of these, 9.0% (15/167) and 7.1% (12/169) treated with IXE and ADA, respectively, were taking an additional csDMARD (sulfasalazine, cyclosporine, or leflunomide). A significantly greater proportion of patients on IXE versus ADA achieved the primary endpoint or PASI 100 when used as monotherapy or in combination with csDMARD (Figure 1A and 1C). At Wk 52, the proportion of patients achieving ACR50 was not statistically different between IXE and ADA, regardless of monotherapy or concomitant csDMARD use (Figure 1B). A significantly higher proportion of patients achieved MDA on IXE compared to ADA in the monotherapy subgroup (49% vs 33%), while the response rates were similar in both combination subgroups (Figure 1D). These data support consistent ACR50, PASI 100, and MDA response for IXE across all three subgroups. Frequencies of adverse events were similar across the three subgroups for IXE and ADA (Figure 2).

Conclusion:

As with prior studies,2,3consistent efficacy across multiple PsA disease-specific endpoints was observed with IXE in SPIRIT-H2H, regardless of whether IXE was taken as monotherapy or in combination with MTX or another csDMARD. No unexpected safety signals were found for either agent.

References:

[1]Mease et al, Ann Rheum Dis 2020;79:123-31.

[2]Coates et al, RMD Open 2017;3:e000567.

[3]Nash et al, RMD Open 2018;4:e000692.

Disclosure of Interests:

Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Anthony Sebba Consultant of: Genentech, Gilead, Lilly, Regeneron Pharmaceuticals Inc., Sanofi, Speakers bureau: Lilly, Roche, Sanofi, Eric Ruderman Consultant of: Pfizer, Amanda Gellett Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Aubrey Trevelin Sprabery Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Sreekumar Pillai Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Paulo Reis Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB

AB0154 MERTK AND THE RESOLUTION OF INFLAMMATION IN IGG4-RELATED DISEASE

Background:

IgG4-Related Disease (IgG4-RD) is characterized by fibrotic lesions, serum IgG4 elevation, and prompt response to glucocorticoids. B and T lymphocytes are considered the initiators of tissue inflammation in IgG4-RD, but the prominent stromal reaction observed at disease sites suggest that a dysregulation of processes involved in the resolution of inflammation could be pathologically relevant as well. Mer receptor tyrosine kinase (MerTK) and its ligands protein S (Pros1) have a pivotal role in the resolution of inflammation through the activation of a well-characterized signaling pathway that ultimately dampens the immune response and promotes the recovery of tissue function. MerTK and the processes involved in the resolution of inflammation have never been addressed in IgG4-RD.

Objectives:

To investigate MerTK involvement in the pathogenesis of IgG4-RD by evaluating (a) the expression of MerTK and of its endogenous ligands in IgG4-RD tissues; (b) the presence of circulating precursors of MerTK+ cells infiltrating IgG4-RD lesions in the peripheral blood of IgG4-RD patients; (c) the effects of immunosuppressive therapies on MerTK expression in IgG4-RD tissues.

Methods:

Three distinct cohorts of IgG4-RD patients were included in this study. 8 active patients were used for immunohistochemistry studies for MerTK expression. 16 IgG4-RD and 14 Sjögren syndrome patients, together with 6 control tonsils, were used for multicolor immunofluorescence studies and TissueQuest software quantification of the expression of MerTK, CD68, CD163, Pros1, Gas6, CD4, SLAMF7, CD19, IgG4, cleaved caspase-3. 10 untreated IgG4-RD patients were used to evaluate MerTK expression in circulating monocytes subsets and fibrocytes by flow cytometry.

Results:

MerTK was highly expressed in IgG4-RD affected organs. MerTK+ cells accounted on average for 16% (range 5-35%) of all cells in the tissue, and the majority of them expressed CD68,reflecting a monocyte-macrophage origin. 33.5 % (interquartile range (IQR) 26-41%) of MerTK+ cells co-expressed CD68 and CD163, while 30.5% (IQR 19-41.5%) expressed CD68 but not CD163. CD68+MerTK+ cells displayed two main morphological appearances, compatible with those of macrophages and of myofibroblasts. In addition, MerTK+ cell number was significantly increased in salivary glands from IgG4-RD patients compared to Sjögren syndrome (p < 0.0001). Circulating precursors of CD68+MerTK+ cells infiltrating IgG4-RD lesions were identified by flow cytometery in the peripheral blood of patients with active IgG4-RD as MerTK+ populations of intermediate monocytes, nonclassical monocytes and collagen expressing fibrocytes. MerTK ligand Pros1 was exposed on 52% (IQR 42-57%) of infiltrating B lymphocytes, 74% (IQR 54-89%) of infiltrating T lymphocytes, and, likely, on apoptotic cells that were detected in IgG4-RD tissues. CD68+MerTK+ cells were found in physical contact with Pros1+ cells in IgG4-RD lesions and their number decreased by 56% after successful treatment with rituximab.

Conclusion:

MerTK is abundant in IgG4-RD affected organs and is preferentially expressed on CD68+ macrophages and myofibroblasts that infiltrate IgG4-RD lesions. MerTK+ cells might interact with apoptotic cells and Pros1 expressing T and B lymphocytes in IgG4-RD tissues, leading to the persistent activation of processes involved in the resolution of inflammation and promoting the development of tissue fibrosis.

Disclosure of Interests:

None declared

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Chemical compass behaviour at microtesla magnetic fields strengthens the radical pair hypothesis of avian magnetoreception

The fact that many animals, including migratory birds, use the Earth's magnetic field for orientation and compass-navigation is fascinating and puzzling in equal measure. The physical origin of these phenomena has not yet been fully understood, but arguably the most likely hypothesis is based on the radical pair mechanism (RPM). Whilst the theoretical framework of the RPM is well-established, most experimental investigations have been conducted at fields several orders of magnitude stronger than the Earth's. Here we use transient absorption spectroscopy to demonstrate a pronounced orientation-dependence of the magnetic field response of a molecular triad system in the field region relevant to avian magnetoreception. The chemical compass response exhibits the properties of an inclination compass as found in migratory birds. The results underline the feasibility of a radical pair based avian compass and also provide further guidelines for the design and operation of exploitable chemical compass systems.

Abstract 1846: Acid sensing G protein-coupled receptor OGR1 is required for acid induced adiposomogenesis in breast cancer cells

Malignant tumors exhibit altered metabolism and consume higher levels of glucose compared to surrounding normal tissue, resulting in acidic extracellular microenvironment. Acidity in the microenvironment is a critical stress factor and selection force for the evolution of aggressive tumor types. There are several acid sensing cell surface receptors and ion channels (ASICs) that can sense acidity in the microenvironment; among them proton sensing G protein-coupled receptors (GPCRs) such as OGR1 (GPR68), TDAG8 (GPR65), GPR4 and GPR132 form a major class of acid receptors. Our previous studies demonstrated that acid adaptation is associated with survival mechanisms like chronic activation of autophagy and redistribution of the lysosomal proteins to the plasma membrane. When grown under acidic pH, breast cancer cells accumulate lipids as revealed by staining with Nile Red and perilipin 2, a protein that coats adiposomes or lipid droplets. These are dynamic organelles that store neutral lipids surrounded by a shell of proteins and a phospholipid monolayer. The lipids stored in adiposomes are produced de novo, as acid-induced lipogenic phenotype is maintained, even if cells are grown with de-lipidated serum. Inhibition of fatty acid synthesis was selectively toxic under acidic conditions and attenuated adiposome accumulation. Among the acid sensing receptors, TDAG8 and OGR1 are highly expressed in a panel of breast cancer cell lines compared to non-malignant breast epithelial cells. Highly invasive and acid tolerant MDA-MB-231 cells express significantly higher levels of TDAG8 while MCF7 and T47D cells have high levels of OGR1. We investigated the role of these receptors in transducing the acid signal that results in the accumulation of lipid droplets. CRISPR/Cas9 mediated depletion of the major acid sensors in breast cancer cell lines MCF7 and T47D showed that depletion of OGR1, not TDAG8, specifically inhibited acid induced adiposome accumulation. Additionally, inducing the cells with ogerin, an allosteric activator of OGR1 resulted in adiposomogenesis. Further, OGR1 knock out cells showed inhibition in cell growth under acidic growth conditions compared to OGR1 expressing cells. OGR1 knockout cells were defective in acid induced autophagy. OGR1 is coupled with Gq/11 and, upon ligand (H+) binding, triggers activation of phospholipase C stimulating the formation of the second messenger IP3. Adiposome formation was inhibited in presence of PLC inhibitors, Edelfosine or U73122. These results indicate that OGR1 is the major acid sensing GPCR in these cells that mediate adiposomogenesis. Accumulation of adiposomes is a highly regulated process related to storing autophagic products, and appears to be important in cell survival in acid stress. Taken together, increased dependence on lipid metabolism by cancer cells under acidic conditions reveals novel therapeutic vulnerabilities.

Citation Format: Smitha Pillai, Michael Langsen, Jonathan Nguyen, Jonathan Wojtkowiak, Marilyn Bui, Robert Gatenby, Robert Gillies. Acid sensing G protein-coupled receptor OGR1 is required for acid induced adiposomogenesis in breast cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1846.

Clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis: a review

Immunoglobulin G4-related disease (IgG4-RD), recognized only recently as a single diagnostic entity, is a chronic inflammatory condition of unknown etiology. The diagnosis of IgG4-RD relies heavily on histopathological analysis and the correlation of histology findings with clinical, serological, and radiological data. CD4⁺ T and B cells, including IgG4-expressing plasmablasts, constitute the major inflammatory cell populations in IgG4-RD and are believed to cause organ damage and tissue fibrosis. Patients with IgG4-RD, who have active, untreated disease, exhibit marked expansion of IgG4-secreting plasmablasts in the blood. Important mechanistic insights correlated with the pathogenesis of IgG4-RD have been disclosed in recent years through the application of novel molecular biology approaches, including next-generation and single-cell RNA sequencing. Exploration of the interactions between these CD4⁺ T cells and cells of the B lymphocyte lineage is critical to understanding the pathophysiology of IgG4-RD. The establishment of pathogenic T cell clones and the identification of antigens specific to these clones constitute the first steps in determining the pathogenesis of this disease. This review focuses on clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis, from a perspective suitable for oral and maxillofacial surgeons.

Interferon priming is essential for human CD34+ cell-derived plasmacytoid dendritic cell maturation and function

Plasmacytoid dendritic cells (pDC) are essential for immune competence. Here we show that pDC precursor differentiated from human CD34+ hematopoietic stem and progenitor cells (HSPC) has low surface expression of pDC markers, and has limited induction of type I interferon (IFN) and IL-6 upon TLR7 and TLR9 agonists treatment; by contrast, cGAS or RIG-I agonists-mediated activation is not altered. Importantly, after priming with type I and II IFN, these precursor pDCs attain a phenotype and functional activity similar to that of peripheral blood-derived pDCs. Data from CRISPR/Cas9-mediated genome editing of HSPCs further show that HSPC-pDCs with genetic modifications can be obtained, and that expression of the IFN-α receptor is essential for the optimal function, but dispensable for the differentiation, of HSPC-pDC percursor. Our results thus demonstrate the biological effects of IFNs for regulating pDC function, and provide the means of generating of gene-modified human pDCs.

A Combination of Essential Fatty Acids, Panax Ginseng Extract, and Green Tea Catechins Modifies Brain fMRI Signals in Healthy Older Adults

OBJECTIVES

To assess the effects of a combination of omega 3 essential fatty acids, green tea catechins, and ginsenosides on cognition and brain functioning in healthy older adults.

DESIGN

Double-blind, placebo-controlled, crossover design randomized controlled trial with 26-day intervention phases and a 30-day washout period.

SETTING

The Institute for Dementia Research and Prevention at the Pennington Biomedical Research Center.

PARTICIPANTS

Ten independently-living, cognitively-healthy older adults (mean age: 67.3 + 2.01 years).

INTERVENTION

Daily consumption of an investigational product (trade name "Cerbella TM") consisting of an emulsified liquid combination of standardized fish oil, panax ginseng extract, and green tea catechins in a flavored base of lecithin phospholipids optimized to maximize bioavailability of the active ingredients.

MEASUREMENTS

Before and after supplementation with the investigational product or placebo, participants completed cognitive tests including the Mini Mental State Exam (MMSE), Stroop test, Digit Symbol Substitution Test (DSST), and Immediate and Delayed Recall tests, as well as functional magnetic resonance imaging (fMRI) during a standard cognitive task switching paradigm.

RESULTS

Performance on the MMSE, Stroop test, and DSST increased significantly over one month of supplementation with the investigational product (one-sample t tests, p<.05) although differences between these changes and corresponding changes during supplementation with placebo were not significant (two-sample t tests, p>.05). During supplementation with the investigational product, brain activation during task performance increased significantly more than during supplementation with placebo in brain regions known to be activated by this task (anterior and posterior cingulate cortex). Functional connectivity during task execution between task regions (middle frontal gyrus and anterior cingulate cortex) increased significantly during supplementation with the investigational product, relative to placebo. Functional connectivity during rest between task regions (precentral gyrus and middle frontal gyrus) and default mode network regions (medial frontal gyrus and precuneus) decreased during supplementation with the investigational product relative to placebo, suggesting greater segregation of task and rest related brain activity.

CONCLUSION

One-month supplementation with a combination of omega 3 essential fatty acids, green tea catechins, and ginsenosides was associated with suggestive changes in cognitive functioning as well as modification of brain activation and brain functional connectivity in cognitively healthy older adults.

Abstract 3460: TBK1 regulates mitotic progression by modulating spindle assembly checkpoint in cancer cells

TANK Binding Kinase 1 (TBK1) is a non-canonical IkB kinase that contributes to KRAS-driven lung cancer. It is activated by phosphorylation of Serine-172 by TLR and RIG1 signaling, and this circuit triggers phosphorylation of IRF3 and IRF7, activation of NFκB and the expression of proinflammatory genes and interferons. In addition to its role role in regulating innate immunity, TBK1 also promotes oncogenesis by phosphorylating Akt and enhancing cell survival and by promoting autophagy and mitophagy. TBK1 is also induced under hypoxic conditions and expressed at significant levels in many solid tumors. TBK1 also contributes to prostate cancer dormancy and drug resistance by inhibiting mTOR and to tamoxifen resistance of breast cancer cells by enhancing transcriptional activity of ERα.

Recent studies from our lab revealed a novel role for TBK1 in regulating mitosis. It was found that levels of phospho-TBK1 increases and localizes to centrosomes and the mitotic spindles during mitosis. Depletion of TBK1 was shown to trigger defects in spindle apparatus and prevents mitotic progression (Pillai et al., Nature Communications, 2015). TBK1 physically interacts and phosphorylates centrosomal protein CEP170 and mitotic apparatus protein NuMA. At the same time, it is not clear whether TBK1 regulates mitosis my modulating the Spindle Assembly Checkpoint (SAC).

Our results show that TBK1 colocalizes with Cdc20 on the centrosomes. Additionally, TBK1-inhibited cells showed an increase in the colocalization of BUBR1 and Cdc20, with enhanced recruitment of BUBR1 to kinetochores. To further study how TBK1 affects SAC, lung and breast cancer cells were depleted of TBK1 by CRISPR/Cas9 mediated genome editing. Cells depleted of TBK1 showed very few cells in the mitotic stage; those that entered mitosis had residual levels of TBK1 and showed multipolarity and unusually stable and bundled microtubules. TBK1 knockout cells not only showed aberrant mitotic structures and had elevated levels of SAC components including BUBR1 and Cdc20. Surprisingly, level of mitotic Cyclin B1 remained unchanged in spite of elevated levels of Cdc20 indicating a possible inactivation of Anaphase Promoting complex (APC/C). Also, percentage of Cyclin B1 positive cells was significantly high in mitotic cells enriched using double thymidine block in the presence of TBK1 inhibitor BX795 (R9+BX) and MRT67307 (R9+MRT) as compared to untreated mitotic cells (R9). Further, double thymidine blocked released cells displayed elevated levels of SAC components upon treatment with TBK1 inhibitors. All these findings suggest that TBK1 facilitates mitotic progression through satisfying SAC.

Citation Format: Neha Jaiswal, Smitha Pillai, Namrata BoraSinghal, Srikumar Chellappan. TBK1 regulates mitotic progression by modulating spindle assembly checkpoint in cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3460. doi:10.1158/1538-7445.AM2017-3460

Abstract 3538: Enhanced dependence on lipid metabolism is a cellular adaptation to acidic microenvironment

Malignant tumors exhibit altered metabolism and consume higher levels of glucose compared to surrounding normal tissue, resulting in highly acidic microenvironment. Adaptation to acidic conditions is a pre-requisite for tumor cells to survive and thrive and to out-compete the stroma into which they invade. Acid adaptation is associated with chronic activation of autophagy as well as redistribution of the lysosomal proteins to the plasma membrane. These processes are major survival mechanisms adopted by tumor cells under acidic conditions. We have also observed that under acidic conditions, there is a rapid, reversible and robust increase in the accumulation of cytoplasmic lipid droplets (adiposomes) in a panel of breast cancer cells. Adiposomes are dynamic organelles that store neutral lipids surrounded by a shell of proteins and a phospholipid monolayer. Breast cancer cells when grown in acidic media accumulated adiposomes as revealed by nile red and perilipin-2 staining followed by confocal microscopy. The acid-induced lipogenic phenotype persists even when the cells are grown in de-lipidated serum, indicating that the source of lipids is de-novo and endogenous. When cells were treated with inhibitors of fatty acid synthesis such as TOFA, an inhibitor of Acetyl CoA Carboxylase or FAS inhibitor C75, adiposome formation at low pH was attenuated. Inhibition of either lipid anabolic or catabolic pathways was specifically cytotoxic in acid-adapted cells, but not in control cells where the FAS inhibitor, C75, is selectively toxic under acidic conditions. Additionally, when treated with etomoxir, an inhibitor of carnitine palmitoyltransferase 1, the rate limiting step in βeta-oxidation, acid adapted cells showed increased sensitivity. To investigate the role of de novo fatty acid synthesis further, we employed high resolution NMR spectroscopy to measure 13C enriched lactate isotopomers following metabolism of D-[1,2-13C] glucose. These analyses showed that glucose flux through the pentose phosphate pathway (PPP) was significantly (&gt;2.5 fold) higher in low pH exposed cells, compared to controls, representing a major shift in glucose metabolism from Embden Meyerhof to PPP, which results in increased production of NADPH, necessary for de novo lipid synthesis. Additional metabolic profiling using the Seahorse XF revealed that cells at low pH had higher rates of oxygen consumption (OCR) and that this was reversible. Further, we investigated the role of various acid sensing G-protein coupled receptors such as OGR1, TDAG8 and GPR4 in transducing the acid signal that results in the accumulation of lipid droplets. CRISPR/Cas9 mediated depletion of these receptors indicates that they might play a major role in inducing adiposome accumulation under acidic conditions. Taken together, increased dependence on lipid metabolism by cancer cells under acidic conditions reveals novel therapeutic vulnerabilities.

Citation Format: Smitha Pillai, Jonathan W. Wojtkowiak, Mehdi Damaghi, Robert Gatenby, Robert Gillies. Enhanced dependence on lipid metabolism is a cellular adaptation to acidic microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3538. doi:10.1158/1538-7445.AM2017-3538

Interaction of silver nanoparticles with algae and fish cells: a side by side comparison

Background

Silver nanoparticles (AgNP) are widely applied and can, upon use, be released into the aquatic environment. This raises concerns about potential impacts of AgNP on aquatic organisms. We here present a side by side comparison of the interaction of AgNP with two contrasting cell types: algal cells, using the algae Euglena gracilis as model, and fish cells, a cell line originating from rainbow trout (Oncorhynchus mykiss) gill (RTgill-W1). The comparison is based on the AgNP behavior in exposure media, toxicity, uptake and interaction with proteins.

Results

(1) The composition of exposure media affected AgNP behavior and toxicity to algae and fish cells. (2) The toxicity of AgNP to algae was mediated by dissolved silver while nanoparticle specific effects in addition to dissolved silver contributed to the toxicity of AgNP to fish cells. (3) AgNP did not enter into algal cells; they only adsorbed onto the cell surface. In contrast, AgNP were taken up by fish cells via endocytic pathways. (4) AgNP can bind to both extracellular and intracellular proteins and inhibit enzyme activity.

Conclusion

Our results showed that fish cells take up AgNP in contrast to algal cells, where AgNP sorbed onto the cell surface, which indicates that the cell wall of algae is a barrier to particle uptake. This particle behaviour results in different responses to AgNP exposure in algae and fish cells. Yet, proteins from both cell types can be affected by AgNP exposure: for algae, extracellular proteins secreted from cells for, e.g., nutrient acquisition. For fish cells, intracellular and/or membrane-bound proteins, such as the Na⁺/K⁺-ATPase, are susceptible to AgNP binding and functional impairment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12951-017-0254-9) contains supplementary material, which is available to authorized users.

106 ASSESSMENT OF ANTI-BACTERIAL EFFECTS OF PEGYLATED SILVER-COATED CARBON NANOTUBES ON CAUSATIVE BACTERIA OF BOVINE INFERTILITY USING BIOLUMINESCENCE IMAGING SYSTEM

Pathogenic bacteria including Escherichia coli and Salmonella sp. are the major causative agents of endometritis and can cause infertility in livestock animals. Antibiotics are commonly used to terminate bacterial infections, but the development of bacterial antibiotic resistance is often encountered. Nanotechnology associated with silver nanoparticles has been highlighted as an alternative anti-bacterial agent, and pegylated silver-coated single-walled carbon nanotubes have high anti-bacterial effects and are non-toxic to human and murine cells in vitro. Here we verified whether a real-time bioluminescence monitoring system could be an alternative tool to assess anti-bacterial effects of nanotubes in a noninvasive approach. Escherichia coli and Salmonella sp. were transfected with plasmids containing constructs for luciferase enzyme (LuxCDABE) and substrate (luciferin) to create self-illuminating bioluminescent bacteria. Pathogens were grown in LB broth at 37°C, adjusted to 107 cfu mL−1, and placed in 96-well plates for treatments. Pegylated (pSWCNTs-Ag) and non-pegylated (SWCNTs-Ag) nanotubes were prepared and added to culture wells at various concentrations (31.25–125 µg mL−1). The control group corresponded to bacteria without nanotubes (0 µg mL−1). Anti-bacterial effects of nanotubes were determined every 10 min until 1 h, then every 30 min up to 6 h incubation through optical density (600 nm) measurements and bioluminescence imaging (BLI) and quantification using an IVIS system. Optical density and BLI data were compared at each time-point using 2-way ANOVA, with P < 0.05 set for significance. Bioluminescence signals emitted by both bacteria stains appeared within 10 min of incubation. Thereafter, control bacteria showed exponential growth that was detected as early as 25 min post-incubation. Bioluminescence imaging revealed dose-dependent anti-bacterial activities of both pSWCNTs-Ag and SWCNTs-Ag on each E. coli and Salmonella sp. (P < 0.05). Contrary to BLI, the OD values did not always reflect bacteria concentrations, and varied according to nanotube concentrations. No significant differences in anti-bacterial activities were revealed between pSWCNTs-Ag and SWCNTs-Ag based on OD values during 6 h of incubation (P > 0.05); meanwhile, pSWCNTs-Ag nanotubes exhibited stronger anti-bacterial effects than SWCNTs-Ag during the same period using BLI (P < 0.05). In summary, we confirmed previous reports showing dose-dependent eliminations of pathogenic bacteria by silver nanotubes. Pegylated nanotubes exhibited high anti-bacterial activity compared to non-pegylated nanotubes. Bioluminescence imaging system revealed superior resolution to enable precise investigation of anti-bacterial kinetics of silver nanotubes. This feature could be useful for the study of bacterial infections that impair livestock fertility. Work was supported by USDA-ARS Biophotonics Initiative grant #58-6402-3-018.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Abstract P5-04-06: Analysis of STEAP1 expression as a therapeutic target in breast cancer

Objective: The six transmembrane epithelial antigen of the prostate (STEAP1) is predominantly overexpressed in human prostate cancer. STEAP1 was first identified as a prostate-specific cell-surface antigen and found to be up-regulated in various cancers including lung, bladder, colon, and ovarian with little expression in normal tissue. An anti-STEAP1 monoclonal antibody linked to an antimitotic agent is currently in Phase I clinical trials for prostate cancer patients. Microarray data from our lab suggested that STEAP1 is also highly expressed in human breast cancers and bone marrow disseminated tumor cells. In this study we evaluate expression STEAP1 in primary tumors, and bone marrow (BM) from breast cancer patients.

Experimental procedures: RNA was isolated from primary tumor, non-malignant breast tissue and bone marrow (BM) from stage II and III breast cancer patients, healthy volunteers, breast cancer cell lines and BM from patient derived xenographs (PDX). Disseminated tumor cells (DTCs) from patient BM were enriched by microfiltration and analyzed by RNA-in situ hybridization (ISH). STEAP1 RNA expression was analyzed by Nanostring nCounter and qRT-PCR using human specific probes. STEAP1 immunohistochemical (IHC) staining of human tissue was performed using standard protocols. Knockdown of steap1 expression was accomplished using a lentiviral system.

Results: STEAP1 mRNA was up-regulated in 77% of tumors (28/36) compared to the corresponding normal tissue. STEAP1 protein was expressed in 100% of tumors (8/8) and was absent in non-malignant breast tissue (7/7) by IHC staining. STEAP1 mRNA was not expressed normal BM, but was detected in 8% (6/74) of BM from patients with early stage breast cancer. STEAP1 expression in the BM was associated with triple negative disease (3/6) and recurrent disease development (4/6, p=.028). STEAP1 expression was observed in individual DTCs isolated from patients BM, while no expression was observed in normal BM. In a PDX model of breast cancer, STEAP1 expression in BM was only observed in mouse who developed metastatic disease associated (7/10, p=.004). Knockdown of STEAP1 in the breast cancer cell line MDA-MB231 cells inhibited cell growth by 80-90%.

Conclusion: STEAP1 is expressed in human breast tumors and disseminated tumor cells found in the bone marrow of breast cancer patients. Expression of STEAP1 in the BM is significantly associated with the development of metastatic disease in patients as well as in a mouse model of breast cancer. Our data indicate that STEAP1 could serve as a therapeutic target for the treatment of minimal residual disease in breast cancer.

Citation Format: Aft R, Mudalagiriyappa C, Pillai S, Watson M. Analysis of STEAP1 expression as a therapeutic target in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-04-06.

Overview of ion source characterization diagnostics in INTF

INdian Test Facility (INTF) is envisaged to characterize ITER diagnostic neutral beam system and to establish the functionality of its eight inductively coupled RF plasma driver based negative hydrogen ion source and its beamline components. The beam quality mainly depends on the ion source performance and therefore, its diagnostics plays an important role for its safe and optimized operation. A number of diagnostics are planned in INTF to characterize the ion source performance. Negative ions and its cesium contents in the source will be monitored by optical emission spectroscopy (OES) and cavity ring down spectroscopy. Plasma near the extraction region will be studied using standard electrostatic probes. The beam divergence and negative ion stripping losses are planned to be measured using Doppler shift spectroscopy. During initial phase of ion beam characterization, carbon fiber composite based infrared imaging diagnostics will be used. Safe operation of the beam will be ensured by using standard thermocouples and electrical voltage-current measurement sensors. A novel concept, based on plasma density dependent plasma impedance measurement using RF electrical impedance matching parameters to characterize the RF driver plasma, will be tested in INTF and will be validated with OES data. The paper will discuss about the overview of the complete INTF diagnostics including its present status of procurement, experimentation, interface with mechanical systems in INTF, and integration with INTF data acquisition and control systems.

Ductal Plate Malformation in the Liver of Boxer Dogs: Clinical and Histological Features

Ductal plate malformations (DPMs) represent developmental biliary disorders with a wide phenotypic spectrum. This study characterizes DPM in 30 Boxer dogs. Median age was 1.5 (range, 0.3-10.0) years, with 12 dogs <1 year. Clinical features included increased serum levels of liver enzymes (28), gastrointestinal signs (16), poor body condition (14), abdominal effusion (9), and hepatic encephalopathy (2). Additional malformations included gallbladder atresia (8), atrophied left liver (2), absent quadrate lobe with left-displaced gallbladder (1), portal vasculature atresia (left liver, 1), intrahepatic portosystemic shunt (1), and complex intrahepatic arteriovenous malformation (1). All dogs had portal tracts dimensionally expanded by a moderate-to-severe multiple small bile duct phenotype embedded in abundant extracellular matrix; 80% displayed variable portal-to-portal bridging. Quantitative analysis confirmed significantly increased fibrillar collagen and a 3-fold increased portal tract area relative to 6 Boxer and 10 non-Boxer controls. Biliary phenotype was dominated by tightly formed CK19-positive ductules, typically 10 to 15 μm in diameter, with 3 to >30 profiles per portal tract, reduced luminal apertures, and negative Ki-67 immunoreactivity. CK19-positive biliary epithelium intersected directly with zone 1 hepatocytes as a signature feature when considered with other DPM characteristics. Phenotypic variation included a multiple small bile duct phenotype (all dogs), predominantly thin-walled sacculated ducts (4), well-formed saccular ducts (4), and sacculated segmental, interlobular, and intralobular ducts (Caroli malformation, 2 dogs, one with bridging portal fibrosis). Histologic evidence of portal venous hypoperfusion accompanied increased biliary profiles in every case. We propose that this spectrum of disorders be referred to as DPM with appropriate modifiers to characterize the unique phenotypes.

Gilles de la Tourette syndrome in a cohort of deaf people

We present six patients with Gilles de la Tourette syndrome (TS) who are also deaf. TS has been observed previously, but rarely reported in deaf people, and to date, so called "unusual" phenomenology has been highlighted. TS occurs almost worldwide and in all cultures, and the clinical phenomenology is virtually identical. In our cohort of deaf patients (we suggest another culture) with TS, the phenomenology is the same as in hearing people, and as in all other cultures, with classic motor and vocal/phonic tics, as well as associated phenomena including echo-phenomena, pali-phenomena and rarer copro-phenomena. When "words" related to these phenomenon (e.g. echolalia, palilalia, coprolalia or mental coprolalia) are elicited in deaf people, they occur usually in British Sign Language (BSL): the more "basic" vocal/phonic tics such as throat clearing are the same phenomenologically as in hearing TS people. In our case series, there was a genetic predisposition to TS in all cases. We would argue that TS in deaf people is the same as TS in hearing people and in other cultures, highlighting the biological nature of the disorder.